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Community Ophthalmology – I
Dr.Swathi.NOphthalmology
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• Blindness• Vision 2020
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Approach to eye related problems
Clinical : Remedial measures targeting individuals
Community : Remedial measures directed towards
whole community
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“Community Ophthalmology can be defined as the use of full scope of ophthalmic and public health knowledge ,skills and services to promote the ocular health status of groups of people, particularly at the community level, thereby directly improving the quality of life of individuals, families and communities.”
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Multidisciplinary approach
Rehabilitation of blind people
Reduce the ocular ill-health
Promote the quality of life
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Objectives: Treat and improve the eye health of the entire
community
Information needed: Data on the magnitude of the eye problems in
the community, available eye health services etc.
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Diagnosis: Community diagnosis, eye problems and
needs
Action: Community based eye care programmes
Evaluation: Impact of interventions on overall ocular health
status of populations including reduction of blindness
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BlindnessDevastating physical condition
Emotional ,social and economic implications.
Affects the individual, the family and the community
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Prevention :
• Definition
• Magnitude
• Etiology
• Control
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WHO Definition
Category of visual impairment BCVA in the better eye
0 Normal 6/6 -6/18 (can see 6/18 or better) 1 Visual impairment <6/18 -6/60 (cannot see 6/18,can see 6/60)2 Severe visual impairment <6/60-3/60 (cannot see 6/60,can see 3/60) (Economic Blindness)3 Blind (Social blindness) <3/60-1/60 (cannot see 3/60,can see 1/60)4 Blind (Legal blindness) <1/60-only PL (cannot see 1/60,can see light)5 Blind (Complete/total) No PL (cannot see light)9 Undetermined / Unspecified
Visual field loss:
3 <10 ° but > 5° around central fixation4 <5° around central fixation even if V/A is not impaired.
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Global Magnitude of Blindness• 45 million – blind
• 35 million - visually disabled
• 60% of global blindness in Sub Saharan Africa, China and India
• 9/10 blind individuals in the world live in Developing countries
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PrevalenceBlindness Prevalence Rate: > 1% in general population
Significant Public Health Problem
WHO Recommendations:• National Blindness Rate <0.5%• Individual Communities <1%
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Etiology
• Cataract (47.8%)• Glaucoma (12.3%) 68.8% of global blindness• ARMD (8.7%)• Corneal opacity (5.1%)• Diabetic Retinopathy (4.8%)• Childhood blindness (3.9%)• Trachoma (3.6%)• Onchocerciasis (0.8%) • Others (13.0%)
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• Developed countries: ARMD Glaucoma Diabetic Retinopathy Cataract
• Developing Countries: Cataract Trachoma Vit A deficiency Onchocerciasis Glaucoma
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Control of Blindness
Based on:
• Strategy • Disease oriented approach• Services oriented approach • Community approach
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Strategies
• Primary Prevention: Prevention of disease
• Secondary Prevention: Prevention of visual loss
• Tertiary Prevention: Restoration of sight
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Disease-oriented approach
Cataract – surgery
Vitamin A – supplementation
Trachoma control
Screening of school children
Onchocerciasis - Distribution of Ivermectin
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Services oriented approach
Primary care services:
- Promotive and preventive, also curative measures
- Education and community participation
- Community based
- Training of health workers.
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Secondary eye care:
Management of common blinding conditions Training and supervision of health personnel Hospital based Adequate infrastructure to handle common
blinding conditions incl correction of refractive errors, cataract, entropion and trichiasis, corneal ulcers endophthalmitis, ocular trauma and PACG.
Screening for POAG and Diabetic Retinopathy
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Tertiary eye care:
Management of conditions which require highly specialized staff and sophisticated equipments
Specialized treatments like corneal grafting, Paed cataract surgery, RD surgery, Ocular malignancies
Expert technical leadership, Training of personnel involved at secondary level
Research activities
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Community approach
Specific blindness control measures directed towards population at risk
Increase awareness, assessment, assistance and reduction of disability
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VISION 2020: The Right to Sight
Trends & Projections in Global Blindness
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VISION 2020 Partnership
WHOVISION
2020
NGDOsProfessions
Corporations
NATIONALVISION 2020
BODIES
IAPB
Ministries of
Health
DISTRICT VISION 2020 SERVICE UNITS
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District Level Implementation
Eye Care Team
Equipment & Supplies
Community-Patients
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Service Delivery Model for VISION 2020
Advanced Tertiary
Tertiary
Secondary
Primary
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Principles
Integrated
Sustainable
Equitable
Excellent
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International Agency for the Prevention of Blindness
Founded in 1975 it now has 108 members:
n International NGOs
n Professional Bodies
n Universities
n Corporate Companies
Governed by a Board of Trustees and Council of Members Head office in London, UK
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VISIONA world in which no one is needlessly blind or visually impaired and where those with unavoidable vision loss can achieve their full potential.
MISSIONPromotes the global initiative VISION 2020: The Right to Sight- to eliminate the
main causes of avoidable blindness by the year 2020.
-brings together governments and non-governmental agencies
- to facilitate the planning, development and implementation of sustainable national eye care programmes
- based on the three core strategies of disease control, human resource development and infrastructure development,
-incorporating the principles of primary health care.
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Diseases covered in vision 2020
• Cataract
• Trachoma
• Onchocerciasis
• Childhood blindness
• Refractive errors & low vision
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• Write a note on Vision 2020• Give the WHO definition of blindness• Name the diseases that are covered under
Vision 2020 in India.• Give 4 causes of preventable blindness• Write a note on school eye screening• Name 4 causes for childhood blindness
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Symposium on 22.09.16
• Vision 2020
• NPCB
• DBCS
• Childhood blindness
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Thank you